Shoulder and Knee Injury Car Accident Settlements: The Factors

The shoulder is injured in crashes by three mechanisms. The driver braces against the steering wheel and the impact loads the arm into the shoulder joint, tearing the rotator cuff or the labrum. The seatbelt crosses the shoulder and in a frontal crash decelerates the torso through it, which can tear the cuff or fracture the collarbone. And in side impacts, the shoulder strikes the door. Rotator cuff tears, labrum tears, dislocations and separations are the results.

The knee is injured mainly by the dashboard. In a frontal crash, the knees strike the dashboard or the steering column, producing the injury pattern sometimes called dashboard knee: meniscus tears, posterior cruciate ligament tears, patella fractures and, in severe cases, hip injuries from the force transmitted up the femur. Twisting injuries to the ACL and MCL occur when the foot is planted on a pedal during impact.

These are mechanical injuries with recognized mechanisms, and that matters for the claim. When the insurer argues that a rotator cuff tear is degenerative, the answer begins with the fact that the driver's hands were on the wheel at impact, which is what drivers do.

Rotator cuff tears and meniscus tears are common in people over 40 with no injury at all, and MRI studies of pain-free people regularly find them. Insurers know this, and the standard response to a shoulder or knee claim is that the tear was there before the crash and the crash at most caused a temporary strain on top of it. The argument is strongest when the injured person is older and when there is any history of shoulder or knee complaints.

The answer is in the records and the imaging. Acute tears look different from chronic ones on MRI, with edema and bleeding that radiologists describe, and the surgeon who repairs the tear sees its character directly and documents it in the operative report. A person with no prior complaints, no prior imaging, a recognized crash mechanism and symptoms that began within days has a strong causation case. A person with years of prior treatment for the same joint has a harder one, though aggravation of a pre-existing condition is compensable everywhere.

The practical lesson is to describe the mechanism to the first doctor, to disclose any prior problems with the joint honestly, and to follow through on the MRI and the orthopedic referral, because the imaging and the surgeon's findings are what settle the argument.

Suppose you were driving when another car ran a stop sign and you braked hard, bracing against the wheel, before the impact. Your right shoulder hurt immediately, and after three weeks of worsening pain and weakness an MRI showed a full-thickness rotator cuff tear. You had arthroscopic repair, six weeks in a sling, and four months of physical therapy. At eight months you had recovered most motion but could not lift overhead without pain, and your work as an electrician required exactly that. You were 48 and had never had shoulder treatment.

Medical bills totaled $41,000, lost wages $18,000 over four months, and your return to work was on modified duties. The surgeon's report described an acute full-thickness tear with findings consistent with a traumatic cause, rated a permanent impairment, and noted overhead work restrictions.

The insurer's first offer treated the injury as a degenerative tear made symptomatic by a strain. The operative report describing the tear's acute character, the absence of any prior history, the bracing mechanism and the occupational effect answered it, and the claim was valued as a surgical joint injury with permanent restriction in a trade that depends on the shoulder. The other driver carried $100,000 in coverage. All figures are hypothetical.

Joint claims are decided on the imaging, the operative findings and the history, and each can be protected from the first visit.

• Describe the mechanism to the first doctor: hands on the wheel at impact, the belt across the shoulder, the knee striking the dashboard.
• Report shoulder or knee symptoms at the first visit even if they seem secondary to a neck or back injury; a joint complaint that first appears at week six is one the insurer attributes to something else.
• Get the MRI the doctor orders; a joint claim without imaging is valued as a strain.
• Disclose any prior shoulder or knee problems to every provider, and describe your function before the crash.
• Follow the surgeon's rehabilitation plan completely; a joint repair that is not rehabilitated is argued as the cause of any lasting limitation.
• Ask the surgeon at discharge for documented range of motion, strength, permanent restrictions and the risk of arthritis.
• Document the effect on your work in writing, with your employer's confirmation of modified duties or lost hours.

In no-fault states, a surgically repaired joint injury with documented permanent limitation usually meets the threshold for suing the at-fault driver for pain and suffering. New York's serious injury definition includes permanent consequential limitation and significant limitation of a body function; Florida requires permanent injury within a reasonable degree of medical probability; Michigan's serious impairment standard is met by most surgical joint injuries that affect daily life. A strain that resolves does not meet any of them.

Comparative negligence applies as in any crash, and the contributory negligence states, Alabama, Maryland, North Carolina and Virginia, can bar recovery for any fault. Damage caps on non-economic damages, where they exist, affect permanent joint injuries because the lasting limitation is the larger part of the claim. Prior degeneration does not reduce the at-fault driver's responsibility under the rule, applied everywhere, that the driver takes the injured person as found.

The deadline runs from the crash: one year in Tennessee and Kentucky, two in Texas, California, Florida and Georgia, three in New York and North Carolina. Joint injuries often take months to diagnose and a year to treat, so a claim in a one-year state may need to be filed before the surgeon has given a final opinion.

Searches for an average rotator cuff or torn meniscus settlement return figures that are invented or drawn from a few reported cases, and none of them account for the single fact that decides most of these claims: whether the insurer's degeneration argument was answered. A claim where the tear is accepted as traumatic and repaired surgically is valued in one range; the same tear argued successfully as pre-existing is valued as a strain.

Within accepted claims, the value depends on surgery, recovery, permanent limitation, the person's work and the coverage available, exactly as with any injury. An electrician and an accountant with identical rotator cuff repairs have different claims.

An attorney values a joint claim by the operative findings, the surgeon's final report and comparison with similar claims in the same venue, which is the only comparison that predicts anything.

A shoulder or knee claim is a claim where the insurer's first position is that the injury was already there, and where the imaging, the operative report and the history are what answer it. The questions to answer early are whether the tear is confirmed on MRI, whether the mechanism is documented, whether any prior history has been disclosed, and whether the surgeon has described the permanent effect. Most personal injury attorneys work on contingency.

Ask Legal Matters is a free claim-review request service, not a law firm. Requests may be shared with independent attorneys and legal services partners who handle inquiries in your state, and an attorney must evaluate the medical facts before anyone can say what the claim is worth. If a crash left you with a shoulder or knee injury that needed surgery or has not resolved, you can request a free claim review.

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